title: Mortality and causes of death after traumatic spinal cord injury in Estonia.
abstract: METHODS
  Retrospective population-based study with mortality follow-up.
  
  
  OBJECTIVE
  To study mortality, causes and risk factors for death in Estonian patients with traumatic spinal cord injury (TSCI).
  
  
  METHODS
  All Estonian hospitals.
  
  
  METHODS
  Medical records of patients with TSCI from all regional, central, general, and rehabilitation hospitals in Estonia from 1997 to 2007, were retrospectively reviewed. Mortality status was ascertained as of 31 December 2011. Causes of death were collected from the Estonian Causes of Death Registry. Standardized mortality ratios (SMRs) were calculated for the entire sample and for causes of death. A Cox proportional hazards modeling was used to identify the risk indicators for death.
  
  
  RESULTS
  During the observation period (1997-2011) 162 patients of 595 died. Nearly half of the patients (n = 76) died during the first year after TSCI. The main causes of death were external causes (30%), cardiovascular disease (29%). and suicide (8%). The overall SMR was 2.81 (95% confidence interval 2.40-3.28) and SMR was higher for women than for men (3.80 vs. 2.70). Cause-specific SMRs were markedly elevated for sepsis and suicide. Mortality was significantly affected by the age at the time of injury, neurological level, and extent of the injury as well as the year of TSCI and complications.
  
  
  CONCLUSIONS
  Life expectancy is significantly decreased in patients with TSCI in Estonia compared with the general population. Deaths during the first year after the injury have an important impact on statistics. Treatment of cardiovascular diseases, infections, and prevention of suicide are useful for reducing mortality in patients with TSCI.
authors.affiliation: University of Tartu, Tartu, Estonia.
authors.forename: Liis
authors.initials: L
authors.lastname: Sabre
authors.affiliation: Haukeland University Hospital, Bergen, Norway.
authors.forename: Tiina
authors.initials: T
authors.lastname: Rekand
authors.affiliation: University of Tartu, Tartu, Estonia.
authors.forename: Toomas
authors.initials: T
authors.lastname: Asser
authors.affiliation: University of Tartu, Tartu, Estonia.
authors.forename: Janika
authors.initials: J
authors.lastname: Kõrv
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004957:Estonia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000401:mortality*; D055815:Young Adult